LAUSR

I congratulate the AAN Guideline Subcommittee for the recent update regarding the treatment of painful diabetic neuropathy (PDN).1 These recommendations provide a formal evidence base for clinicians to consider oral and topical treatments for patients suffering with PDN; however, in practice, a great number of patients do not achieve adequate benefit through oral treatment or topical pharmacotherapy. This reality is consistent with the data summarized in the recently published update. In fact, most of the patients with PDN discontinue first-line and second-line treatments within 6 months of commencement because of ineffectiveness or intolerability, without subsequent switches to alternatives.2 This leaves a large patient population with significant untreated pain.